Pan Am Clinic, Winnipeg, Manitoba, Canada.
Pan Am Clinic, Winnipeg, Manitoba, Canada.
J Hand Surg Am. 2023 Oct;48(10):1059.e1-1059.e9. doi: 10.1016/j.jhsa.2022.02.020. Epub 2022 May 8.
Current teaching suggests that modified Mason type III and IV fractures of the radial head involving more than 3 fragments should be treated with radial head arthroplasty. The purpose of this study was to compare the outcome of simple (2 or fewer intra-articular pieces) versus comminuted (3 or more intra-articular pieces) radial head fractures treated with open reduction internal fixation (ORIF).
This was a retrospective review of 35 patients with modified Mason type III and IV fractures treated with ORIF. For the purpose of our study, simple fractures were defined as having 2 or fewer intra-articular fragments. Comminuted fractures were defined as having 3 or more intra-articular fragments. The primary outcomes were Broberg and Morrey rating system and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Reoperation rates and complications were also noted.
Thirty-five patients were evaluated, with a mean follow-up of 39.3 months. Thirteen patients had radial head fractures consisting of 2 or fewer intra-articular fragments. Twenty-two patients had radial head fractures consisting of 3 or more intra-articular fragments. Ages and follow-up times were similar in the 2 groups. Similar QuickDASH and Broberg and Morrey scores were seen when evaluating subgroups of 2, 3, and 4 fragment fractures. One patient from each group underwent revision surgery for symptomatic hardware.
In our series, we found similar clinical outcome scores and reoperation rates between simple and comminuted radial head fractures treated with ORIF. Fractures with more than 3 intra-articular fragments can be considered for ORIF.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
目前的教学建议认为，涉及超过 3 个碎片的改良 Mason 型 III 和 IV 型桡骨头骨折应采用桡骨头置换术治疗。本研究的目的是比较切开复位内固定（ORIF）治疗单纯（2 个或更少关节内碎片）与粉碎性（3 个或更多关节内碎片）桡骨头骨折的结果。
这是一项对 35 例改良 Mason 型 III 和 IV 型骨折患者行 ORIF 治疗的回顾性研究。为了进行本研究，将单纯性骨折定义为具有 2 个或更少的关节内碎片。粉碎性骨折定义为具有 3 个或更多的关节内碎片。主要结果是 Broberg 和 Morrey 评分系统和快速上肢功能测试（QuickDASH）评分。还记录了再手术率和并发症。
35 例患者得到评估，平均随访 39.3 个月。13 例患者桡骨头骨折由 2 个或更少的关节内碎片组成。22 例患者桡骨头骨折由 3 个或更多的关节内碎片组成。两组患者的年龄和随访时间相似。当评估 2、3 和 4 个碎片骨折的亚组时，观察到相似的 QuickDASH 和 Broberg 和 Morrey 评分。每组中有 1 例患者因症状性内固定而接受了翻修手术。
在我们的系列研究中，我们发现 ORIF 治疗单纯性和粉碎性桡骨头骨折的临床结果评分和再手术率相似。超过 3 个关节内碎片的骨折可以考虑行 ORIF。
研究类型/证据水平：治疗性 IV 级。
